It’s a defense of allowing health care to emerge from the bottom-up rather the top-down. Cochrane explains why the current legal and regulatory framework keep those bottom-up solutions from happening already.

Here is an excerpt where he begins to address some of the standard attacks on a private, voluntary health care system. But it doesn’t do it justice. Do read the whole thing.

“What about the homeless guy with a heart attack?”

Let’s not confuse the issue with charity. The goal here is to fix health insurance for the vast majority of Americans –people who buy houses, cars, and cell phones; people who buy insurance for their houses and life insurance so their families.

Yes, we will also need charity care for those who fall through the cracks, the victims of awful disasters, the very poor, and the mentally ill. This will be provided by government and by private charity. It has to be good enough to fulfill the responsibilities of a compassionate society, and just bad enough that few will choose it if they are capable of making choices. I wish it could be better, but that’s the best that is possible. For people who are simply poor, but competent, vouchers to buy health insurance or to refill health savings accounts make plenty of sense.

But supplying decent charity care does not require a vast “middle‐class” entitlement, and regulation of health insurance and health care for everyone in the country, any more than providing decent homeless shelters (which we are pretty scandalously bad at) or housing subsidies for the poor (section 8) requires that we apply ACA style payment and regulation to your and my house, Holiday Inn or the Four Seasons. To take care of homeless people with heart attacks, where does it follow that your and my health insurance must cover first‐dollar payment for wellness visits and acupuncture? The ACA is hardly a regulation minimally crafted to solve the problems of homeless people with heart attacks!